Keywords: Lymphomatoid papulosis
, cutaneous CD30+ lymphoproliferative disorders.
lesions appear as small self-healing papules, with a necrotic center that often appears in clusters and recurs in the same region of the body.
Scharer et al., "Angioinvasive lymphomatoid papulosis
: a new variant simulating aggressive lymphomas," The American Journal of Surgical Pathology, vol.
The cutaneous T cell lymphomas (CTCL) include diverse malignancies: mycosis fungoides (MF), Sezary syndrome, lymphomatoid papulosis
(LyP), anaplastic large-cell lymphoma (ALCL) and many less known varieties.1 Clinical presentation, histology, and immunophenotype must be considered together to establish the specific subtype and ensure appropriate treatment and management.2,8 Diagnosis is not easy and multiple biopsies are often required.8 Recently recognized primary cutaneous CD30+ ALCL constitutes approximately 10 percent of all CTCL cases.2 Diagnosis is based on predominance (greater than 75%) of large clusters of CD30+ blast cells, no clinical evidence of LyP, no prior or concurrent LyP, MF, or other cutaneous lymphoma; and no extra-cutaneous lesion at presentation.2,6,7,9
Conditions resulting in inflammatory hemorrhage include leukocytoclastic or necrotizing vasculitis, although a few nonvasculitic conditions can be associated with palpable purpura and include chronic pigmented purpura, pityriasis lichenoides et varioliformis acuta (PLEVA), lymphomatoid papulosis
, and erythema multiforme.
The main morphologic clue in distinguishing primary cutaneous acral [CD8.sup.+] T-cell lymphoma from [CD8.sup.+] variants of mycosis fungoides, [CD8.sup.+] aggressive T-cell lymphoma, and type D lymphomatoid papulosis
, is epidermotropism.
is a rare, chronic, and benign papulonodular or papulonecrotic skin disorder.
EORTC, ISCL, and USCLC consensus recommendations for the treatment of primary cutaneous CD30-positive lymphoproliferative disorders: lymphomatoid papulosis
and primary cutaneous anaplastic large-cell lymphoma.
In addition, many types of cutaneous lymphoma can have similar histomorphologic features--for example, some tumoral lesions of mycosis fungoides (MF) with large cell transformation cannot be reliably distinguished from anaplastic large cell lymphoma or lymphomatoid papulosis
by hematoxylin-eosin sections or even IHC.
Incorrect diagnoses occur mainly because many diseases are mistakenly diagnosed as spider bites, including many conditions much more prevalent and serious, such as staphylococcal or streptococcal infection, herpes simplex and zoster, erythema multiforme, diabetic ulcer, fungal infection, pyoderma gangrenosum, lymphomatoid papulosis
, syphilis, and Lyme disease.
diabetic ulcer, fungal infection, pyoderma gangrenosum, lymphomatoid papulosis
. syphilis, and Lyme disease, are mistakenly diagnosed as spider bites.